The invention relates to a pneumatic impact tool or striking tool, respectively, particularly for surgical use. The tool has a housing, a cylinder/piston arrangement with a pneumatically driven oscillating piston, and a tool holder which is provided outside the housing with a tool adapter and which forms two impact faces for the piston inside the housing. The tool selectively generates strikes in forward direction or in rearward direction, respectively. The invention further relates to a piston for a pneumatic impact tool.